Introduction
Conformance within healthcare can be described as a continuous progression of consultation or beyond the professional, legitimate, and principled regulations about a specific medical center or insurer. The department that manages the health and human services through the Inspector General oversees the compliance of various healthcare regulations. The department has established a framework to help assess the implementation of policies in the healthcare industry. It has helped develop a culture that detects, resolves, and prevents cases of misappropriation of government laws, ethical and conduct policies, and billing of private and public payers in health care. The boundaries of compliance extend to patient care, research qualities, and reimbursement, among many others. This paper aims to explore the issue of healthcare compliance by looking at various regulations.
Main text
In the United States, many organizations provide healthcare services such as the American Cancer Society. Its purpose is to help guide cancer patients through their experiences from diagnosis through treatment and by providing care and emotional support (American Association for Cancer Research, 2020). Smith (2020) states that an organization’s governing body is usually responsible for its conduct. Due to this, the governing body and the organization’s executive officials bear full responsibility for healthcare compliance or lack of compliance. Therefore, it becomes necessary to direct the administrators to develop and impose a compliance program and authorize funds to oversee the task. According to the American Association for Cancer Research, society has different regulatory authorities (American Association for Cancer Research, 2020). The authorities touch on various fields such as disease prevention, regulation of drugs and food consumed, and employees’ safety at work.
Regulation of healthcare entities can be affected by private or public agencies within state, federal, and local county governments, based on the extent of the need to improve quality, enhance access and manage expenses in the sector (Oemig & Snelick, 2016). All healthcare personnel are subject to scrutiny and, in most cases, both by the non-government and government agencies. The state and federal agencies share regulation and governance by third-party payers. According to Smith (2020), the insurance industry falls within the interstate trade framework and is liable to Congressional federal antitrust regulations. However, States have been granted, to some extent, the power to control and tax insurance products of third-party payers. Many, if not all, jurisdictions, under their health codes, forbid insurers from engaging in fraudulent activities in their jurisdictions. However, Oemig and Snelick (2016) recommend that if the state has ineffective controls on health insurance policies to be sold to small businesses and individuals and small businesses, the federal government will take over. It will happen if the national health insurance premiums rise by 10 % annually.
Management of medical services suppliers- hospitals and doctors are usually guided by the state and federal level through public bodies, national non – governmental. Doctors, nurses, and several allied health practitioners receive state-level accreditation from regulatory authorities (Smith, 2020). The State boards’ responsibility is to enforce and renew the standards of medical. In a report released in 2020 by World Health Organization, physicians are also monitored at the federal level by the CMS (Centers for Medicare & Medicaid Programs) by establishing payment services rendered(American Association for Cancer Research, 2020). For example, Medicare requires doctors to meet strict standards, many of which exceed state licensing requirements. In addition, hospitals are governed by federal regulations over who should be treated in hospitals.
Pharmaceutical Regulation- The FDA primarily regulates pharmaceutical products in the United States at the federal level. The purpose of forming the FDA was to control the increasing public health epidemics primarily caused by unsafe drugs and foods (American Association for Cancer Research, 2020). Thus, all laws that deal with food and health fraud regulation are undertaken at the federal law, and all states are forbidden from introducing any contrary law aside from the federal one.
Regulation of public health is usually undertaken by OSHA (occupational safety and health administration) at the federal level. It is charged with mitigation of damages caused to employees’ health care from hazards in their workplaces (American Association for Cancer Research, 2020). However, state laws regulate this sector of health through government agencies in different areas such as cemetery and burial, garbage collection, and affordable housing.
The primary purpose of healthcare compliance is to better the care of patients. Noncompliance with the legislation always leads to the misappropriation of clinical standards. In turn, it results in the delivery of a low-quality car (American Association for Cancer Research, 2020). Apart from that, it leaves health institutions and personnel at risk for financial loss, security breaches, license revocation, loss of trust, and a damaged reputation.
The policies that an organization can implement to reduce noncompliance are to come up with an effective compliance program. According to Oemig and Snelick (2016), the program should address issues like, use of internal tracking and audits to evaluate compliance among the hospital personnel and the institution in general. Besides, an organization should develop and implement a process to respond to complaints, including a guideline of instilling employees’ discipline when the need arises. The program should also include a developed strategy for delivering effective training and education to the employees.
Monitoring procedures serve as the bridge to involve health care organizations and address critical compliance issues. According to Smith (2020), compliance with some high-risk regulations begins from the patient’s entry into the facility. A normal monitoring process would include acts such as sampling data, validating information, identifying risk areas, among many others (Smith, 2020). Monitoring compliance with the law, procedures, and policies is another way of evaluation. It entails the development of tools by an organization to aid accountable leaders in verifying essential legal activities focusing on accuracy and consistency. A monitoring process can be done in different ways, such as interviewing personnel and managing reports. It is essential to ensure that the staff in a healthcare organization know where the management stands on compliance by educating them on the law, corrective action measures, and legal policies and procedures (Oemig & Snelick, 2016). Education and re-education initiatives can be put in place for the employees to be accountable for their actions within and without their working places.
Conclusion
In conclusion, this paper has successfully discussed the issue of compliance in healthcare. As seen in the paper, compliance in healthcare is indeed crucial as it improves patient care and promotes quality services. Besides, it also helps in avoiding distress with the authorities of the government. Therefore, it is vital for hospitals always to ensure total compliance with all healthcare regulations to avoid trouble with the law.
References
American Association for Cancer Research. (2020). Federal agencies and cancer research Programs | AACR. Web.
Oemig, F., & Snelick, R. (2016). Healthcare interoperability standards compliance handbook. Springer International Publishing AG.
Smith, M. (2020). Healthcare compliance: An overview of the basics for organizations and providers. The Health Law Firm. Web.